title: Cost-effectiveness of new oral anticoagulants compared with warfarin in preventing stroke and other cardiovascular events in patients with atrial fibrillation.
abstract: OBJECTIVE
  The primary objective was to assess the cost-effectiveness of new oral anticoagulants compared with warfarin in patients with nonvalvular atrial fibrillation. Secondary objectives related to assessing the cost-effectiveness of new oral anticoagulants stratified by center-specific time in therapeutic range, age, and CHADS2 score.
  
  
  METHODS
  Cost-effectiveness was assessed by the incremental cost per quality-adjusted life-year (QALY) gained. Analysis used a Markov cohort model that followed patients from initiation of pharmacotherapy to death. Transition probabilities were obtained from a concurrent network meta-analysis. Utility values and costs were obtained from published data. Numerous deterministic sensitivity analyses and probabilistic analysis were conducted.
  
  
  RESULTS
  The incremental cost per QALY gained for dabigatran 150 mg versus warfarin was $20,797. Apixaban produced equal QALYs at a higher cost. Dabigatran 110 mg and rivaroxaban were dominated by dabigatran 150 mg and apixaban. Results were sensitive to the drug costs of apixaban, the time horizon adopted, and the consequences from major and minor bleeds with dabigatran. Results varied by a center's average time in therapeutic range, a patient's CHADS2 score, and patient age, with either dabigatran 150 mg or apixaban being optimal.
  
  
  CONCLUSIONS
  Results were highly sensitive to patient characteristics. Rivaroxaban and dabigatran 110 mg were unlikely to be cost-effective. For different characteristics, apixaban or dabigatran 150 mg were optimal. Thus, the choice between these two options may come down to the price of apixaban and further evidence on the impact of major and minor bleeds with dabigatran.
authors.affiliation: Faculty of Medicine, Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada.
authors.forename: Doug
authors.initials: D
authors.lastname: Coyle
authors.forename: Kathryn
authors.initials: K
authors.lastname: Coyle
authors.forename: Chris
authors.initials: C
authors.lastname: Cameron
authors.forename: Karen
authors.initials: K
authors.lastname: Lee
authors.forename: Shannon
authors.initials: S
authors.lastname: Kelly
authors.forename: Sabine
authors.initials: S
authors.lastname: Steiner
authors.forename: George A
authors.initials: GA
authors.lastname: Wells
mesh_terms: D000284:Administration, Oral; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications* / Q000191:economics; D001562:Benzimidazoles / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000191:economics / Q000209:etiology / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D000069604:Dabigatran; D016527:Drug Costs; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D009025:Morpholines / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D011720:Pyrazoles / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D011728:Pyridones / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D000069552:Rivaroxaban; D020521:Stroke / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D013876:Thiophenes / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D013997:Time Factors; D014859:Warfarin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D015091:beta-Alanine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D009025:Morpholines; D011720:Pyrazoles; D011728:Pyridones; D013876:Thiophenes; D015091:beta-Alanine; C522181:apixaban; D014859:Warfarin; D000069552:Rivaroxaban; D000069604:Dabigatran